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In Case You Missed It:

Is sex exercise? And is it hard on the heart?

At some time in his life, nearly every man gets exercised about
sex. And as many men get older, they wonder if sex is a good form
of exercise or if it's too strenuous for the heart. These
questions may sound like locker room banter, but they are
actually quite important — and they now have solid scientific
answers.

Treadmill vs. mattress

To evaluate the cardiovascular effects of sexual activity,
researchers monitored volunteers while they walked on a treadmill
in the lab and during private sexual activity at home. In
addition to 13 women, the volunteers included 19 men with an
average age of 55. About three-quarters of the men were married,
and nearly 70% had some form of cardiovascular disease; 53% were
taking beta blockers. Despite their cardiac histories, the men
reported exercising about four times a week, and they reported
having sexual activity about six times a month on average.

Researchers monitored heart rate and blood pressure during
standard treadmill exercise tests and during "usual" sexual
activity with a familiar partner at home. All the sex acts
concluded with vaginal intercourse and male orgasm.

Disappointedly perhaps, the treadmill proved more strenuous.
During sex, the men raised their heart rates only 72% as high as
they did on the treadmill, and the average blood pressure during
sex was just 80% as high as during maximal treadmill exercise. On
an intensity scale of 1 to 5, with 5 being the highest, men
evaluated treadmill exercise as 4.6 and sex as 2.7. Sex was even
less strenuous for women in terms of heart rate, blood pressure,
and perceived intensity of exertion.

Sex as exercise

Men seem to spend more energy thinking and talking about sex than
on the act itself. During sexual intercourse, a man's heart rate
rarely gets above 130 beats a minute, and his systolic blood
pressure (the higher number, recorded when the heart is pumping
blood) nearly always stays under 170. All in all, average sexual
activity ranks as mild to moderate in terms of exercise
intensity. As for oxygen consumption, it comes in at about 3.5
METS (metabolic equivalents), which is about the same as doing
the foxtrot, raking leaves, or playing ping pong. Sex burns about
five calories a minute; that's four more than a man uses watching
TV, but it's about the same as walking the course to play golf.
If a man can walk up two or three flights of stairs without
difficulty, he should be in shape for sex.

Sex as sex

Raking leaves may increase a man's oxygen consumption, but it
probably won't get his motor running. Sex, of course, is
different, and the excitement and stress might well pump out
extra adrenaline. Both mental excitement and physical exercise
increase adrenaline levels and can trigger heart attacks and
arrhythmias, abnormalities of the heart's pumping rhythm. Can sex
do the same? In theory, it can. But in practice, it's really very
uncommon, at least during conventional sex with a familiar
partner.

Careful studies show that fewer than one of every 100 heart
attacks is related to sexual activity, and for fatal arrhythmias
the rate is just one in 200. Put another way, for a healthy
50-year-old man, the risk of having a heart attack in any given
hour is about one in a million; sex doubles the risk, but it's
still just two in a million. For men with heart disease, the risk
is 10 times higher — but even for them, the chance of suffering a
heart attack during sex is just 20 in a million. Those are pretty
good odds.

Sex and survival

A man's heart may swell with love, but is sex swell for
his heart?

Possibly so, according to a report from the United
Kingdom. Researchers evaluated 918 men who were in good
general health when the study began. Each man provided
information on the frequency of his sexual activity; over
the next 10 years, the men who reported three or more
orgasms per week enjoyed a 50% lower death rate than the
men who ejaculated less often.

A report from the Massachusetts Male Aging Study agrees
that sex may be protective. The subjects were men between
40 and 70 who were randomly selected residents of the
Boston area. A total of 1,165 men were eligible for the
study and agreed to participate. None of the men had
cardiovascular disease when they enrolled in the 17-year
study; 213 of the men had erectile dysfunction and were
analyzed separately. Among the 952 men with intact
erectile function, men who had sex once a month or less
were 45% more likely to develop cardiovascular disease
than the men who had sex two or more times a week. The
link between sexual activity and cardiac health was not
explained by conventional cardiac risk factors or a man's
satisfaction with his relationships.

Although the American and British findings are
heartening, they do not prove that sex itself is
protective. Another explanation is that sexual activity
reflects a general satisfaction with life that is good
for health. And it's even more likely that the men who
had sex infrequently may have been burdened by social
isolation or by smoking, drinking, drug abuse, or
diseases that impair libido and potency. Men who choose
to discuss these studies with their partners need not
dwell on these major caveats.

How about Viagra?

Until recently, human biology has provided unintentional (and
perhaps unwanted) protection for men with heart disease. That's
because many of the things that cause heart disease, such as
smoking, diabetes, high blood pressure, and abnormal cholesterol
levels, also cause erectile dysfunction. The common link is
atherosclerosis, which can damage arteries in the penis as well
as in the heart.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis)
have changed that. About 70% of men with erectile dysfunction
(ED) respond to the ED pills well enough to enable sexual
intercourse. Sex may be safe for most men with heart disease, but
are ED pills a safe way to have sex?

For men with stable coronary artery disease and well-controlled
hypertension, the answer is yes — with one very, very important
qualification. Men who are taking nitrate medications in any form
cannot use ED pills. This restriction covers all preparations of
nitroglycerin, including long-acting nitrates; nitroglycerin
sprays, patches, and pastes; and amyl nitrate. Fortunately, other
treatments for erectile function — such as the vacuum pump,
alprostadil injections, or urethral tablets — are safe for men
with heart disease, even if they are using nitrates.

Safe sex

Sex is a normal part of human life. For all men, whether they
have heart disease or not, the best way to keep sex safe is to
stay in shape by avoiding tobacco, exercising regularly, eating a
good diet, staying lean, and avoiding too much (or too little)
alcohol. Needless to say, men should not initiate sexual activity
if they are not feeling well, and men who experience possible
cardiac symptoms during sex should interrupt the sexual activity
at once.

With these simple guidelines and precautions, sex is safe for the
heart — but it should be safe for the rest of the body, too.
Sexually transmitted diseases pose a greater threat than sexually
induced heart problems. When it comes to sex, men should use
their heads as well as their hearts.